A good patient? How notions of ‘a good patient’ affect patient-nurse relationships and ART adherence in Zimbabwe

BMC Infectious Diseases

Research Article

Claudius Madanhire¹  Kerry Scott²  Morten Skovdal³  Catherine Campbell⁴  Constance Nyamukapa⁵  Simon Gregson⁵ 

[1] Biomedical Research and Training Institute, Harare, Zimbabwe;Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Department of Public Health, University of Copenhagen, Copenhagen, Denmark;Department of Social Psychology, London School of Economics and Political Science, Houghton Street, WC2A 2AE, London, UK;School of Public Health, Imperial College, London, UK and Biomedical Research and Training Institute, Harare, Zimbabwe;

关键词: Patient-provider relationships;    ART adherence;    HIV/AIDS;    Social representation;    Sub-Saharan Africa;   

DOI  :  10.1186/s12879-015-1139-x

 received in 2015-02-13, accepted in 2015-09-21,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundWhile patient-provider interactions are commonly understood as mutually constructed relationships, the role of patient behaviour, participation in interactions, and characteristics, particularly ideals surrounding notions of ‘good’ and ‘bad’ patients, are under-examined. This article examines social representations of ‘a good patient’ and how these representations affect patient-healthcare provider relationships and antiretroviral treatment (ART) for people living with HIV.MethodsUsing thematic network analysis, we examined interview and focus group transcripts involving 25 healthcare staff, 48 ART users, and 31 carers of HIV positive children, as well as field notes from over 100 h of ethnographic observation at health centres in rural Zimbabwe.ResultsCharacteristics of a good patient include obedience, patience, politeness, listening, enthusiasm for treatment, intelligence, physical cleanliness, honesty, gratitude and lifestyle adaptations (taking pills correctly and coming to the clinic when told). As healthcare workers may decide to punish patients who do not live up the ‘good patient persona’, many patients seek to perform within the confines of the ‘good patient persona’ to access good care and ensure continued access to ART.DiscussionThe notion of a ‘good ART patient’ can have positive effects on patient health outcomes. It is one of the only arenas of the clinic experience that ART patients can influence in their favour. However, for people not conforming to the norms of the ‘good patient persona’, the productive and health-enabling patient-nurse relationship may break down and be detrimental to the patient.ConclusionWe conclude that policy makers need to take heed of the social representations that govern patient-nurse relationships and their role in facilitating or undermining ART adherence.

【 授权许可】

CC BY   
© Campbell et al. 2015